The Choose Home Care Act: Expanding home health access

In 2021, lawmakers in Congress introduced a groundbreaking bill to make it easier for Medicare recipients to recover at home rather than in skilled nursing facilities (SNF). Called the Choose Home Care Act, the bill would give Medicare beneficiaries more options after a hospital discharge by extending additional Medicare coverage to home-based recoveries.  

Introduced in the U.S. Senate and House in October 2021, the Choose Home legislation marked a shift toward family-centered care. By making a pathway to home healthcare easier for more patients, the bill would reduce patients’ exposure to the COVID-19 virus and other contagions, and enhance quality of life. In addition, by reducing Medicare payment of facilities charges, its passage also carries the potential to save over $2.5 billion in Medicare costs during the next decade. 

“This proposed expansion of Medicare’s home health benefit reflects both patients’ preferences and advances in technology that allow us to provide the highest-quality care in a home setting,” Enhabit Home Health & Hospice Vice President of Government Affairs & Policy Counsel Andrew Baird said. “Both before the pandemic and now, we are seeing a growing demand for patients to return to a family setting after their hospital discharge.”  

As an addition to Section 1812 of the Social Security Act, which lists benefits available under Medicare, the Choose Home legislation would allow patients who require further care after a hospital discharge to elect home-based health care without forgoing their Medicare benefits. Currently, patients who do not transfer to a rehabilitation facility or long-term hospital stay must move to a SNF if they want to use their Medicare benefits.  

By contrast, the Choose Home Care Act would allow coverage of services furnished to Medicare beneficiaries in their homes by home health agencies.

According to MedPAC, in 2021 approximately 1.2 million traditional Medicare enrollees used Medicare’s SNF benefit. Under the new bill, it is estimated that more than one-third of them would qualify for home-based recovery.  

Who would be covered in the Choose Home Care Act?

The Choose Home Care Act would affect the growing number of Medicare recipients who need extended care after leaving the hospital but prefer that their recovery take place in their home. More risks and restrictions came to be associated with transfer to an SNF during the COVID-19 pandemic. The number of patients seeking a home-based recovery grew exponentially.  

The expanded coverage is intended for low-acuity patients, meaning those who do not require intensive nursing care. Any Medicare recipient considered high-acuity, or anyone who simply prefers treatment in a SNF, will continue to have that option.

Medicare’s current SNF benefit would continue unchanged.  

To be eligible for the new benefit, a Medicare recipient would have to be living at home — not in a long-term care facility — prior to their hospital stay.

Passage of the bill will not affect Medicare recipients who qualify for transfer to long-term hospital care or for transfer to an inpatient rehabilitation facility.

The Centers for Medicare & Medicaid Services (CMS) would make the determinations of the new benefit. CMS also makes determinations of Medicare’s current SNF benefit.  

What would be covered in the Choose Home Care Act?

The new Medicare benefit would cover nursing, therapy (physical, occupational, speech and language), meals and other nutritional support, home medical supplies, monitoring, medical social services, nonemergency medical transportation and care coordination.

Care conducted via telehealth, such as a session of speech therapy conducted over video, would be also covered. Family and unpaid caregivers would be supported with training and respite care. 

Coverage would include up to 30 days of post-hospital care. As part of that benefit, Medicare recipients would receive up to 360 hours of medical care or supervision during the 30-day period immediately following their hospital discharge. However, because of that 360-hour limit, patients requiring round-the-clock care could reach that maximum in as little as 15 days.  

Home recovery versus SNF: Who decides?

If medical professionals consider home-based recovery clinically appropriate after reviewing the patient’s diagnosis and medical goals, then the patient would be informed of this alternative to their SNF benefit and make the initial decision to pursue home-based care. 

After a patient opts for home-based care, an evaluation is conducted before they discharge from the hospital.

The home recovery scenario would be reviewed for the availability and willingness of caregivers, the scope of services needed, access to quality services and the provision of caregiver training. The patient would then be informed of the evaluation’s findings and give verbal or written consent, which would be recorded in their chart.  

Who’s behind the Choose Home Care Act?

From its beginning, the bill has attracted bipartisan support in both the House and the Senate.

In the health care industry, prominent endorsements have come from the National Association for Home Care & Hospice, a nonprofit representing 33,000 home care and hospice organizations; and the Partnership for Quality Home Healthcare, which represents community- and hospital-based, nonprofit and proprietary home health care agencies. Moving Health Home, the Council of State Home Care & Hospice Associations and the NAHC Forum of State Associations were also among the list of supporters.

In a statement released after the bill’s introduction last year, NAHC President William A. Dombi said that the bill had attracted “an outpouring of support from America’s home health community as well as consumer and patient advocates.” An opinion poll co-commissioned by the NAHC and PQHH also revealed:

• 94% of Medicare beneficiaries say they would prefer to receive post-hospital short-term health care at home.
• 94% of Medicare beneficiaries — and 86% of adults overall — support the Choose Home Care Act.
• 83% of Republicans and 92% of Democrats support the Choose Home Care Act.

“This bill reflects what patients and their families want and need,” Baird said. “Medicare beneficiaries deserve the choice.